This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in JAMA  Topic Collections  • Revascularization  • Cardiovascular System  • Quality of Care  • Quality of Care, Other  • Surgery  • Surgical Interventions  • Cardiovascular/ Cardiothoracic Surgery  • Congestive Heart Failure/ Cardiomyopathy  • Cardiovascular Intervention  • Alert me on articles by topic  Social Bookmarking   What's this?

The ESCAPE Trial

The ESCAPE Investigators and ESCAPE Study Coordinators*

JAMA. 2005;294:1625-1633.

Context  Pulmonary artery catheters (PACs) have been used to guide therapy in multiple settings, but recent studies have raised concerns that PACs may lead to increased mortality in hospitalized patients.

Objective  To determine whether PAC use is safe and improves clinical outcomes in patients hospitalized with severe symptomatic and recurrent heart failure.

Design, Setting, and Participants  The Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) was a randomized controlled trial of 433 patients at 26 sites conducted from January 18, 2000, to November 17, 2003. Patients were assigned to receive therapy guided by clinical assessment and a PAC or clinical assessment alone. The target in both groups was resolution of clinical congestion, with additional PAC targets of a pulmonary capillary wedge pressure of 15 mm Hg and a right atrial pressure of 8 mm Hg. Medications were not specified, but inotrope use was explicitly discouraged.

Main Outcome Measures  The primary end point was days alive out of the hospital during the first 6 months, with secondary end points of exercise, quality of life, biochemical, and echocardiographic changes.

Results  Severity of illness was reflected by the following values: average left ventricular ejection fraction, 19%; systolic blood pressure, 106 mm Hg; sodium level, 137 mEq/L; urea nitrogen, 35 mg/dL (12.40 mmol/L); and creatinine, 1.5 mg/dL (132.6 µmol/L). Therapy in both groups led to substantial reduction in symptoms, jugular venous pressure, and edema. Use of the PAC did not significantly affect the primary end point of days alive and out of the hospital during the first 6 months (133 days vs 135 days; hazard ratio [HR], 1.00 [95% confidence interval {CI}, 0.82-1.21]; P = .99), mortality (43 patients [10%] vs 38 patients [9%]; odds ratio [OR], 1.26 [95% CI, 0.78-2.03]; P = .35), or the number of days hospitalized (8.7 vs 8.3; HR, 1.04 [95% CI, 0.86-1.27]; P = .67). In-hospital adverse events were more common among patients in the PAC group (47 [21.9%] vs 25 [11.5%]; P = .04). There were no deaths related to PAC use, and no difference for in-hospital plus 30-day mortality (10 [4.7%] vs 11 [5.0%]; OR, 0.97 [95% CI, 0.38-2.22]; P = .97). Exercise and quality of life end points improved in both groups with a trend toward greater improvement with the PAC, which reached significance for the time trade-off at all time points after randomization.

Conclusions  Therapy to reduce volume overload during hospitalization for heart failure led to marked improvement in signs and symptoms of elevated filling pressures with or without the PAC. Addition of the PAC to careful clinical assessment increased anticipated adverse events, but did not affect overall mortality and hospitalization. Future trials should test noninvasive assessments with specific treatment strategies that could be used to better tailor therapy for both survival time and survival quality as valued by patients.

*Authors: Certifying authors are members of the Executive and Publications committees of the ESCAPE trial. Authors/members of the Executive and Publications committees, study investigators, and coordinators are listed above.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Pulmonary Artery Catheter Effectiveness in Congestive Heart Failure
Christine Won and Ware G. Kuschner
JAMA. 2006;295(10):1121.
EXTRACT | FULL TEXT  

Pulmonary Artery Catheter Effectiveness in Congestive Heart Failure—Reply
Lynne W. Stevenson, Christopher M. O’Connor, and Robert M. Califf
JAMA. 2006;295(10):1121-1122.
EXTRACT | FULL TEXT  

RELATED ARTICLES

Impact of the Pulmonary Artery Catheter in Critically Ill Patients: Meta-analysis of Randomized Clinical Trials
Monica R. Shah, Vic Hasselblad, Lynne W. Stevenson, Cynthia Binanay, Christopher M. O’Connor, George Sopko, and Robert M. Califf
JAMA. 2005;294(13):1664-1670.
ABSTRACT | FULL TEXT  

Searching for Evidence to Support Pulmonary Artery Catheter Use in Critically Ill Patients
Jesse B. Hall
JAMA. 2005;294(13):1693-1694.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Hyponatraemia: a strong predictor of mortality in adults with congenital heart disease
Dimopoulos et al.
Eur Heart J 2009;0:ehp495v1-ehp495.
ABSTRACT | FULL TEXT  

A Simple Physiologic Algorithm for Managing Hemodynamics Using Stroke Volume and Stroke Volume Variation: Physiologic Optimization Program
McGee
J Intensive Care Med 2009;24:352-360.
ABSTRACT  

Factors Associated With Neurologically Intact Survival for Patients With Acute Heart Failure and In-Hospital Cardiac Arrest
Levy et al.
Circ Heart Fail 2009;2:572-581.
ABSTRACT | FULL TEXT  

Echocardiographic Evaluation of Diastolic Function Can Be Used to Guide Clinical Care
Little and Oh
Circulation 2009;120:802-809.
FULL TEXT  

Letter by Lancaster et al Regarding Article, "Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients With Advanced Systolic Heart Failure"
Lancaster et al.
Circulation 2009;120:e48-e48.
FULL TEXT  

Response to Letters Regarding Article, "Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients With Advanced Systolic Heart Failure"
Mullens et al.
Circulation 2009;120:e49-e49.
FULL TEXT  

Palliative care in congestive heart failure.
Goodlin
J Am Coll Cardiol 2009;54:386-396.
ABSTRACT | FULL TEXT  

Exploring the Harmful Effects of Health Care
Kilo and Larson
JAMA 2009;302:89-91.
FULL TEXT  

Role of the Brain Natriuretic Peptide in Heart Failure Management
Kalsmith
Circ Heart Fail 2009;2:379-379.
FULL TEXT  

Misclassification of Pulmonary Hypertension Due to Reliance on Pulmonary Capillary Wedge Pressure Rather Than Left Ventricular End-Diastolic Pressure
Halpern and Taichman
Chest 2009;136:37-43.
ABSTRACT | FULL TEXT  

Pharmacological optimization of tissue perfusion
Mongardon et al.
Br J Anaesth 2009;103:82-88.
ABSTRACT | FULL TEXT  

Are BNP Changes During Hospitalization for Heart Failure a Reliable Surrogate for Predicting the Effects of Therapies on Post-Discharge Mortality?
Gheorghiade and Pang
J Am Coll Cardiol 2009;53:2349-2352.
FULL TEXT  

End points for clinical trials in acute heart failure syndromes.
Allen et al.
J Am Coll Cardiol 2009;53:2248-2258.
ABSTRACT | FULL TEXT  

Reduction in Mitral Regurgitation During Therapy Guided by Measured Filling Pressures in the ESCAPE Trial
Palardy et al.
Circ Heart Fail 2009;2:181-188.
ABSTRACT | FULL TEXT  

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
Hunt et al.
J Am Coll Cardiol 2009;53:e1-e90.
FULL TEXT  

2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
Jessup et al.
J Am Coll Cardiol 2009;53:1343-1382.
FULL TEXT  

2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
2009 WRITING GROUP TO REVIEW NEW EVIDENCE AND UPDA et al.
Circulation 2009;119:1977-2016.
FULL TEXT  

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
2005 WRITING COMMITTEE MEMBERS et al.
Circulation 2009;119:e391-e479.
FULL TEXT  

Status of Women in Cardiovascular Clinical Trials
Kim and Menon
Arterioscler. Thromb. Vasc. Bio. 2009;29:279-283.
FULL TEXT  

Noninvasive Cardiac Output Measurement in Heart Failure Subjects on Circulatory Support
Phillips et al.
Anesth. Analg. 2009;108:881-886.
ABSTRACT | FULL TEXT  

Acute heart failure syndromes.
Gheorghiade and Pang
J Am Coll Cardiol 2009;53:557-573.
ABSTRACT | FULL TEXT  

Importance of venous congestion for worsening of renal function in advanced decompensated heart failure.
Mullens et al.
J Am Coll Cardiol 2009;53:589-596.
ABSTRACT | FULL TEXT  

Kidney diseases beyond nephrology: intensive care
Ricci and Ronco
Nephrol Dial Transplant 2009;24:391-395.
FULL TEXT  

Continuous cardiac output and left atrial pressure monitoring by long time interval analysis of the pulmonary artery pressure waveform: proof of concept in dogs
Xu et al.
J. Appl. Physiol. 2009;106:651-661.
ABSTRACT | FULL TEXT  

Acute heart failure syndromes in patients with coronary artery disease early assessment and treatment.
Flaherty et al.
J Am Coll Cardiol 2009;53:254-263.
ABSTRACT | FULL TEXT  

The Swan-Ganz Catheters: Past, Present, and Future: A Viewpoint
Chatterjee
Circulation 2009;119:147-152.
ABSTRACT | FULL TEXT  

Tissue Doppler Imaging in the Estimation of Intracardiac Filling Pressure in Decompensated Patients With Advanced Systolic Heart Failure
Mullens et al.
Circulation 2009;119:62-70.
ABSTRACT | FULL TEXT  

Hemodynamic Monitoring and Shock
Zimmerman
ACCP Pulmonary Med Brd Rev 2009;25:345-358.
FULL TEXT  

CHAPTER 23 Heart Failure
McMurray et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:
Authors/Task Force Members et al.
Eur Heart J 2008;29:2909-2945.
FULL TEXT  

Transesophageal Echocardiography and Noncardiac Surgery
Mahmood et al.
SEMIN CARDIOTHORAC VASC ANESTH 2008;12:265-289.
ABSTRACT  

Changing Preferences for Survival After Hospitalization With Advanced Heart Failure
Stevenson et al.
J Am Coll Cardiol 2008;52:1702-1708.
ABSTRACT | FULL TEXT  

Listening to Patients
Havranek and Allen
J Am Coll Cardiol 2008;52:1709-1710.
FULL TEXT  

Transition From Chronic Compensated to Acute Decompensated Heart Failure: Pathophysiological Insights Obtained From Continuous Monitoring of Intracardiac Pressures
Zile et al.
Circulation 2008;118:1433-1441.
ABSTRACT | FULL TEXT  

Inotropes and Vasopressors: Review of Physiology and Clinical Use in Cardiovascular Disease
Overgaard and Dzavik
Circulation 2008;118:1047-1056.
FULL TEXT  

Value of Clinician Assessment of Hemodynamics in Advanced Heart Failure: The ESCAPE Trial
Drazner et al.
Circ Heart Fail 2008;1:170-177.
ABSTRACT | FULL TEXT  

Sodium nitroprusside for advanced low-output heart failure.
Mullens et al.
J Am Coll Cardiol 2008;52:200-207.
ABSTRACT | FULL TEXT  

Vasodilator therapy for decompensated heart failure.
Yancy
J Am Coll Cardiol 2008;52:208-210.
FULL TEXT  

Cardiorenal Interactions: Insights From the ESCAPE Trial
Nohria et al.
J Am Coll Cardiol 2008;51:1268-1274.
ABSTRACT | FULL TEXT  

Advances in Critical Care for the Nephrologist: Hemodynamic Monitoring and Volume Management
Davison and Junker
CJASN 2008;3:554-561.
ABSTRACT | FULL TEXT  

Fluid Therapy in Resuscitated Sepsis: Less Is More
Durairaj and Schmidt
Chest 2008;133:252-263.
ABSTRACT | FULL TEXT  

New Approaches to Hemodynamic Measurement: Cool Devices But a Shaky Infrastructure
Silver
J Am Coll Cardiol 2007;50:2383-2384.
FULL TEXT  

Comparison of a Radiofrequency-Based Wireless Pressure Sensor to Swan-Ganz Catheter and Echocardiography for Ambulatory Assessment of Pulmonary Artery Pressure in Heart Failure
Verdejo et al.
J Am Coll Cardiol 2007;50:2375-2382.
ABSTRACT | FULL TEXT  

Direct Left Atrial Pressure Monitoring in Ambulatory Heart Failure Patients: Initial Experience With a New Permanent Implantable Device
Ritzema et al.
Circulation 2007;116:2952-2959.
ABSTRACT | FULL TEXT  

Hemodynamic Parameters Are Prognostically Important in Cardiogenic Shock But Similar Following Early Revascularization or Initial Medical Stabilization: A Report From the SHOCK Trial
Jeger et al.
Chest 2007;132:1794-1803.
ABSTRACT | FULL TEXT  

Effects of Tezosentan on Symptoms and Clinical Outcomes in Patients With Acute Heart Failure: The VERITAS Randomized Controlled Trials
McMurray et al.
JAMA 2007;298:2009-2019.
ABSTRACT | FULL TEXT  

Characterization and Prognostic Value of Persistent Hyponatremia in Patients With Severe Heart Failure in the ESCAPE Trial
Gheorghiade et al.
Arch Intern Med 2007;167:1998-2005.
ABSTRACT | FULL TEXT  

Can We Predict and Prevent the Onset of Acute Decompensated Heart Failure?
Wolfel
Circulation 2007;116:1526-1529.
FULL TEXT  

Relation between dose of loop diuretics and outcomes in a heart failure population: Results of the ESCAPE Trial
Hasselblad et al.
Eur J Heart Fail 2007;9:1064-1069.
ABSTRACT | FULL TEXT  

The Pulmonary Artery Catheter in Anesthesia Practice in 2007: An Historical Overview With Emphasis on the Past 6 Years
Leibowitz and Oropello
SEMIN CARDIOTHORAC VASC ANESTH 2007;11:162-176.
ABSTRACT  

Decreased cardiac output, venous congestion and the association with renal impairment in patients with cardiac dysfunction
Damman et al.
Eur J Heart Fail 2007;9:872-878.
ABSTRACT | FULL TEXT  

Trends in the Use of the Pulmonary Artery Catheter in the United States, 1993-2004
Wiener and Welch
JAMA 2007;298:423-429.
ABSTRACT | FULL TEXT  

The Pulmonary Artery Catheter, 1967 2007: Rest in Peace?
Rubenfeld et al.
JAMA 2007;298:458-461.
FULL TEXT  

Acute decompensated heart failure
Allen and O'Connor
CMAJ 2007;177:175-176.
FULL TEXT  

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology
Metra et al.
Eur J Heart Fail 2007;9:684-694.
ABSTRACT | FULL TEXT  

Management of acute decompensated heart failure
Allen and O'Connor
CMAJ 2007;176:797-805.
ABSTRACT | FULL TEXT  

Continuous Renal Replacement Therapy in the Treatment of Acute Renal Failure: Critical Assessment Is Required
Himmelfarb
CJASN 2007;2:385-389.
ABSTRACT | FULL TEXT  

Wireless Acoustic Communication With a Miniature Pressure Sensor in the Pulmonary Artery for Disease Surveillance and Therapy of Patients With Congestive Heart Failure
Rozenman et al.
J Am Coll Cardiol 2007;49:784-789.
ABSTRACT | FULL TEXT  

Complications of Right Heart Catheterization Procedures in Patients With Pulmonary Hypertension in Experienced Centers
Hoeper et al.
J Am Coll Cardiol 2006;48:2546-2552.
ABSTRACT | FULL TEXT  

Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure.
Gheorghiade et al.
JAMA 2006;296:2217-2226.
ABSTRACT | FULL TEXT  

The Year in Epidemiology, Health Services Research, and Outcomes Research
Krumholz and Masoudi
J Am Coll Cardiol 2006;48:1886-1895.
FULL TEXT  

Pulmonary artery catheters
Finfer and Delaney
BMJ 2006;333:930-931.
FULL TEXT  

Update in cardiology.
Rapaport
ANN INTERN MED 2006;145:618-625.
FULL TEXT  

Lessons from ESCAPE: the PAC may not kill, but when should we consider 'tailored' therapy?
Hunt
Eur Heart J Suppl 2006;8:E26-E27.
ABSTRACT | FULL TEXT  

Beta-Blocker Use and Outcomes Among Hospitalized Heart Failure Patients
Butler et al.
J Am Coll Cardiol 2006;47:2462-2469.
ABSTRACT | FULL TEXT  

Utility of Impedance Cardiography for the Identification of Short-Term Risk of Clinical Decompensation in Stable Patients With Chronic Heart Failure
Packer et al.
J Am Coll Cardiol 2006;47:2245-2252.
ABSTRACT | FULL TEXT  

Pulmonary-Artery Catheters -- Peace at Last?
Shure
NEJM 2006;354:2273-2274.
FULL TEXT  

Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury
The National Heart, Lung, and Blood Institute Acut
NEJM 2006;354:2213-2224.
ABSTRACT | FULL TEXT  

Mapping the Journey
Stevenson and Lewis
J Am Coll Cardiol 2006;47:1612-1614.
FULL TEXT  

Pulmonary Artery Catheter Effectiveness in Congestive Heart Failure
Won and Kuschner
JAMA 2006;295:1121-1121.
FULL TEXT  

Hemodynamic Goals Are Relevant
Stevenson et al.
Circulation 2006;113:1020-1033.
FULL TEXT  

JournalScan
Malik
Heart 2006;92:143-144.
FULL TEXT  

Pulmonary Artery Catheter Adds Little in Heart Failure Management
Journal Watch Cardiology 2005;2005:6-6.
FULL TEXT  

Acute Pulmonary Edema
Ware and Matthay
NEJM 2005;353:2788-2796.
FULL TEXT  

The Year in Heart Failure
Tang and Francis
J Am Coll Cardiol 2005;46:2125-2133.
FULL TEXT  

Pulmonary Artery Catheter Adds Little in Heart Failure Management
Journal Watch Cardiology 2005;2005:1-1.
FULL TEXT  

What's new in the other general journals
Tonks
BMJ 2005;331:867-868.
FULL TEXT  

Impact of the Pulmonary Artery Catheter in Critically Ill Patients: Meta-analysis of Randomized Clinical Trials
Shah et al.
JAMA 2005;294:1664-1670.
ABSTRACT | FULL TEXT  

Searching for Evidence to Support Pulmonary Artery Catheter Use in Critically Ill Patients
Hall
JAMA 2005;294:1693-1694.
FULL TEXT